The Care Quality Commission
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Archived: Springfields Residential Home

Overall: Inadequate read more about inspection ratings

Hengist Road, Westgate On Sea, Kent, CT8 8LP (01843) 831169

Provided and run by:
Macari Homes Limited

All Inspections

23 & 26 June 2015

During an inspection looking at part of the service

This inspection took place on 23 and 26 June 2015 and was unannounced.

The home provides accommodation and personal care to up to 20 older people. Bedrooms are on the ground floor and first floor, the first floor is accessed by a stair lift. There are communal lounges and a dining room. There were 10 people living at the home when we inspected.

There was no registered manager; there has been no registered manager since July 2011. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our inspection of 2 and 3 September 2014 we found breaches of seven regulations, most of these breaches had a major impact on the people at the home.

We carried out an unannounced comprehensive inspection of this service on 11and 12 March 2015 and found that most of the breaches continued and there were new breaches of other regulations. On 22 June 2015 we received information of serious concern from the local authority. We were told that people were at serious risk of not receiving the care and support that they needed because there were not enough staff on duty at the home to look after them safely. As a result we undertook an urgent focused inspection to look into those concerns. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Springfield’s Residential Home on our website at www.cqc.org.uk

We found there were not enough staff available throughout the day and night to give people the care and support that they required to make sure their needs where met and they were safe. At times there were only two staff on duty for ten people and four people required the support of two staff. Some staff ignored people when they were distressed and in need of comfort.

Serious risks to people were not recognised, assessed and managed. People were at risk of choking and falling and of being neglected. These risks to people were not being managed leaving people at further risk. People did not get the care and support that they needed. Staff did not always follow the instructions of doctors and nurses to support people’s health needs. When risks had been identified the provider had not followed the guidance given by professionals to keep the risks to a minimum.

Individual risk assessments were not in place to prevent or reduce the likelihood of harm. When risks had been identified, like the risk of choking or risk of developing pressure sores the provider had failed to take action to reduce the risks to make sure people were safe and receiving the care and support that they needed. When people’s health had deteriorated the staff had not recognised this and had not contacted a doctor until they were prompted to do so by external professionals including the CQC inspector. People were at risk of not receiving enough drinks to remain hydrated and healthy.

Care plans were not up to date. People‘s needs had changed but care plans had not been updated so staff were following out of date information. Care plans had not been reviewed and evaluated so staff could not be sure that the support they gave was right for the person.

The provider had not assessed risks posed to people by the environment. Shortfalls in the fire safety precautions had been identified following the last inspection in March 2015 by Kent Fire and Rescue Service (KFRS). The KFRS made several recommendations to ensure the fire safety systems were effective. There were still outstanding recommendations and requirements from the KFRS. The provider did not have an understanding of the key risks and challenges of the home. They had not carried out audits and checks to make sure the home was safe. Risks and hazards to people posed by the environment and equipment had not been checked since April 2015. The registered provider had not given the manager or staff any information about the identified risks found at this check. No action had been taken to address the shortfalls that had been identified in April 2015 and following our previous inspections.

A system to recruit new staff was in place. This was to make sure that the staff employed to support people were fit to do so. However, all the checks that needed to be carried out on staff to make sure they were suitable and safe to work with people had not been completed by the provider. One staff was from overseas, outside of the European Union, there was no evidence that they were in the UK legally.

Staff did not all have the skills and competencies needed to give safe, good quality care and support. Staff were not regularly supervised and had not had a yearly appraisal. When concerns had been raised about the conduct of a staff member no action had been taken to make sure their practise was safe. The induction was not thorough and some staff had not completed it. Staff had not received the all the training they needed look after people safely. Staff had not all received training in protecting people from abuse. Staff knew what abuse was and said they would report to the manager. Some staff did not know that they could report abuse or suspected abuse to outside organisations like the local social services safeguarding team. The manager was not fully aware of their responsibilities about safeguarding people from abuse.

There continued to be imposed restrictions that had not been assessed, consented to and reviewed to be the least restrictive option. People were deprived of the liberty, as the external doors were locked, with no assessment and agreement to make sure this was lawful.

We found a number of breaches and persistent breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We took urgent enforcement action against Macari Homes Limited to protect the health, safety and welfare of people using this service and cancelled the provider's registration with immediate effect.

11 and 12 March 2015

During a routine inspection

This inspection took place on 11 and 12 March 2015 and was unannounced.

At our last inspection of 2 and 3 September 2014 we found breaches of seven regulations, most of these breaches had a major impact on the people at the home. We followed up these breaches at this inspection and found that most of the breaches continued and there were new breaches of other regulations.

The home provides accommodation and personal care to up to 20 older people. Bedrooms are on the ground floor and first floor, the first floor is accessed by a stair lift. There are communal lounges and a dining room. There were 14 people living at the home when we inspected.

There was no registered manager; there has been no registered manager since July 2011. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found the home was not meeting the requirements of the Deprivation of Liberty Safeguards as the provider had not made the appropriate referrals. There were restrictions imposed on people that did not consider their ability to make individual decisions for themselves as required under the Mental Capacity Act (2005) Code of Practice.

When people lacked the mental capacity to make decisions staff were not following the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests.

Potential risks to people were not recognised and assessed. Individual risk assessments were not in place to prevent or reduce the likelihood of harm. The provider had not assessed risks posed to people by the environment. There was a fire risk assessment that had not been reviewed, faulty fire equipment and a lack of fire training and practice drills. Some fire exits were locked and not all the staff had a key. There were environmental hazards including rucked and torn carpets that had not been assessed as safe.

The home was not clean and hygienic. Some bedrooms were dirty and smelled strongly of urine and had carpets that were sticky underfoot. The provider said that staff checked the bedrooms, but this was not recorded. Staff said they had not checked or had time to clean the bedrooms. A relative told us "(My relative’s) room is filthy, the carpet is stained and it smells awful."

Staff knew what abuse was and said they would report to the manager. The manager did not understand her role in safeguarding and had not reported safeguarding concerns to the local authority or to the Care Quality Commission (CQC). People had suffered abuse.

There were usually enough staff on duty, there had been no cleaner for a while so care staff had to take on cleaning tasks. Recruitment checks were not thorough and not in line with the provider’s recruitment policy. Medicines were not always given as prescribed.

Staff did not all have the skills and competencies needed to give safe, good quality care and support. Staff were not regularly supervised and had not had a yearly appraisal. The induction was not thorough and some staff had not completed it.

People did not have the support they needed to reduce the risk of malnutrition and dehydration. Staff did not always follow the instructions of doctors and nurses to support people’s health needs.

Most of the staff were patient and kind but there had been occasions when staff were inconsiderate and disrespectful to people. People were not supported to be fully involved in their care and treatment. People’s dignity was not always protected.

Care plans were not up to date. People‘s needs had changed but care plans had not been updated so staff were following out of date information. Care plans had not been reviewed and evaluated so staff could not be sure that the support they gave was right for the person.

People were not supported to take part in activities they enjoyed. Some people stayed in their rooms and had limited interactions with staff. Staff did not always follow the instructions of nurses and doctors to keep people well and healthy.

The complaints procedure was not meaningful to everyone, relatives told us they had made complaints but nothing had changed. A relative told us "There has been a tap dripping in (my relative’s room) since before Christmas, we have told the staff and so has (our relative) but it hasn't been fixed.”

The provider did not have an understanding of the key risks and challenges of the home. The provider had not carried out audits and checks to make sure the home was safe.

People and staff were not involved in developing and improving the service. Relatives told us that they did not have an opportunity to have their say. One relative said, “It’s all about the fees. They go up but nothing gets done”.

The provider had not assessed risks to people and did not monitor the quality of the service. The provider said they visited and carried out checks but this was not recorded so there were no actions recorded from these visits.

The provider had not supported and supervised the staff team to make sure they displayed the right behaviours and values to people and to each other. The home was not well led and the staff lacked the direction and support they needed to provide safe care.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We took enforcement action and cancelled the provider's registration.

3, 4 September 2014

During a routine inspection

The inspection was carried out by one inspector and took place over two days. Time was spent in the home looking at care records, talking to staff, relatives and people who used the service. We looked at people's care plans, staffing records and quality assurance processes. We set out to answer our five questions;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Is the service safe?

The service was not safe. People's safety was not assured because there was a lack of effective systems that regularly assessed, monitored and managed risks to people's health, welfare and safety.

People who used the service were at risk because the service was not clean and hygienic.

People's individual creams were shared and this increased the risk of cross infection.

Changes in people's needs were not always recorded in their care plans, which meant that staff did not have up to date information about people's needs.

Is the service effective?

The service was not effective. Staff had not completed essential training to enable them to meet people's needs safely.

Consideration had not been given to people's individual capacity and issues that could affect them in relation to any Deprivation of Liberty Safeguards (DOL'S). Staff had not received the appropriate training and lacked understanding about the Mental Capacity Act (2005) and DOL's. Where people did not have the capacity to make a decision there were no records to show how a decision had been made in their best interests. People's changing needs affecting their ability to make a decision had not been considered.

People did not receive the support and encouragement they needed to eat their meals.

Records were incomplete, disorganised and out of date placing people at risk of unsafe care.

Is the service caring?

The service was not consistently caring. People who used the service told us that they felt staff were kind and supportive. Some of our observations supported people's comments. There were times when staff did not always consider people's feelings. Staff did not always ask people's permission before moving them or giving support.

People said that they felt comfortable with the management and staff in the home. People and visitors said they were happy to talk to the manager or staff if there was a problem?

Is the service responsive?

The service was not responsive. Records were poorly maintained so people's care needs were not fully documented and could not be monitored effectively.

People were supported with their health care needs as staff contacted appropriate health care professionals for advice. Recommendations and advice from health care professionals was not always followed by staff.

People knew who to talk to if they had any concerns. There were no records of any complaints or concerns so any actions taken were not documented.

Is the service well led?

The service was not well-led. The registered provider did not have a quality assurance system in place to assess the quality of the service.

There was a lack of support and supervision for the manager.

There were no systems in place to report accidents or incidents.

The manager had an open door policy so that people and their relatives or representatives could speak to the manager when they wished.

16 May 2013

During a routine inspection

Following an inspection on 20 March 2013 we made compliance actions as the service was not compliant with some of the essential standards of quality and safety. We looked at these standards during this inspection and found that the compliance actions had been met.

A new experienced manager had been recruited and had started to address the areas of concern. There was an action plan in place and the manager had identified what needed to improve and had prioritised what was most important.

People's care records had been reviewed and updated so that they were accurate and up to date. The manager had met with people using the service individually to review and update their care plans including risk assessments. The pre admission assessment had been updated and improved.

Staffing levels had been increased and people told us that the staff were attentive and were there when they needed them and that staff came promptly when they used their call bell. The manager had identified gaps in staff training and had started to plan and book courses. A staff meeting had been held and most staff had met with the new manager on a one to one basis for supervision.

Staff were aware of safeguarding procedures and could tell us about different types of abuse and signs of abuse. Staff were aware of what to do if they suspected abuse. Staff spoke to people in a respectful way. People told us that their privacy was respected. People said 'The staff are all very good, very attentive.'

20 March 2013

During a routine inspection

We were not able to communicate with most of the people who used the service due to their conditions of dementia and difficulties with verbal communication so we observed and talked to staff and people's representatives.

Staff we spoke with told us that there were not enough staff on duty to deliver the quality of care they wanted to. We observed that people who needed support to maintain their safety and welfare were left unattended on several occasions throughout the day . We found that some care plans were not up to date and did not include all the necessary risk assessments.

30 July 2012

During a routine inspection

People we spoke to said that they like living at the home and that the staff were friendly and approachable. The People we spoke to confirmed the food was good and there was always a choice. People had access to health care such as dentists, doctors and specialist teams

13 December 2010

During a routine inspection

People told us that they were happy with the care and support they were receiving and that their needs were being met in all areas. They said that the staff treated them with respect, listened to them and supported them to raise any concerns they had about their care. People told us that the service responded to their health needs quickly and that the manager talked to them regularly about their plan of care and any changes that may be needed.

People that use the service told us there was a consistent staff team that created a pleasant atmosphere in the home and that the staff were competent and knew how to care for them safely. Comments from people included 'The staff are all lovely here' and 'It's a much nicer atmosphere here than it used to be'.

People that use the service felt that the social activities on offer in the home had improved and that they now had more to do to keep them occupied during the day. They enjoyed the range of meals available and said the quality of meals was good.

People told us that they had the equipment they needed for their care and that their rooms and other areas of the home were always kept clean and well maintained.